Mal absorption syndrome is a group of disorders marked by Indigestion Excessive nutrients loss in stools Abnormal absorption of dietary constituents It is a state arising from abnormality in absorption of food nutrients across the gastrointestinal tract. Impairment can be of single or multiple nutrients depending on the abnormality. This may lead to malnutrition and a variety of anemia. Malabsorption constitutes the pathological interference with the normal physiological sequence of body.

1. MALABSORPTION
SYNDROME
By
Mr. Ravi Rai Dangi
Assistant Professor
Fellowship in Neonatal Nursing
MSc. Child Health Nursing

2. DEFINITION
Mal absorption syndrome is a group of disorders marked by
 Indigestion
 Excessive nutrients loss in stools
 Abnormal absorption of dietary constituents

3.  It is a state arising from abnormality in absorption of food
nutrients across the gastrointestinal tract.
 Impairment can be of single or multiple nutrients
depending on the abnormality. This may lead to
malnutrition and a variety of anemia.
 Malabsorption constitutes the pathological interference
with the normal physiological sequence of body.

4. CAUSES:
 Bile salt insufficiency:
 Obstructive jaundice
 Bacterial overgrowth
 Infection
Acute infectious enteritis
Parasitic infections, such as giardia, or helminthiasis

5.  Pancreatic disease
 Chronic pancreatitis
 Carcinoma of pancreas

6. Structural defects:
 Inflammatory bowel diseases commonly: Crohn's
Disease

7. Gastrectomy

8. Gastro-jejunostomy

9. Short bowel syndrome.

10.  Lymphatic obstruction
 Intestinal lymphoma
 Intestinal Tuberculosis

11.  It is a pathologic dilation of
lymph vessels. When it occurs
in the intestines of dogs, and
more rarely humans, it causes
a disease known as "intestinal
lymphangiectasis"
Lymphangiectasis

12.  PEM
 Iron deficiency anemia
 Severe Steatorrhea due to cystic fibrosis, celiac
disease

13. CLINICAL MANIFESTATION
 Chronic diarrhea
 Abdominal distension
 Failure to thrive
 Flatulence
 Anorexia

14.  Fatigue
 Weight loss
 Direct consequence of malabsorption which leads to
malnutrition and growth failure
 Malabsorption syndrome and chronic diarrhea is
manifested with three major categories, these are- impaired
digestion, intestinal malabsorption and carbohydrate
malabsorption.

15. Impaired Digestion
 It occurs due to exocrine pancreatic insufficiency also
results in chronic diarrhea and malabsorption.
 Due to cystic fibrosis, lipase deficiency and crohn’s
disease.
 It is manifested as frequent loose pasty, greasy stools with
undigested fat and offensive cheesy smell.

16. Intestinal Malabsorption
 presented with chronic diarrhea as loose or liquid stool.
 These patients have steatorrhea
 This condition is usually associated with celiac disease,
food protein sensitivity, giardiasis, immunodeficiency,
malnutrition and bacterial overgrowth

17. Carbohydrate Malabsorption
 It may be presented as chronic diarrhea due to
fermentation.

18. INVESTIGATION
 History of illness
 Physical examination
 Routine stool examination

19.  Fecal fat studies for steatorrhea
 D-Xylose test ( performed to diagnose conditions that present
with malabsorption of the proximal small intestine)
 Intestinal biopsy
 Radiology test- barium meal study to detect structural defect

20. Specific test- like
 Sweat chloride test for cystic fibrosis (sweat test
measures the concentration of chloride that is excreted
in sweat)
 Blood serology test for celiac disease,
 Hydrogen breath analysis for carbohydrate
malabsorption
 Lactose tolerance test

21. MANAGEMENT
 Replacement of electrolytes and fluid by parental
administration.
 Adequate nutrition intake considering the specific defect.
 Control the diarrhea
 Dietary modification is important in some conditions:
Gluten-free diet in coeliac disease.
Lactose avoidance in lactose intolerance.

22.  Antibiotic therapy will treat Small Bowel Bacterial
overgrowth.
 In cystic fibrosis, the diet should be planned with food
items rich in protein and sugar.
 For carbohydrate malabsorption give glucose and
galactose free diet.
 Pancreatic supplements, antacid and antihistamine are
essential.

23. NURSING MANAGEMENT

24. Assessment
 Daily intake output
 Daily weight
 Vital signs
 Serum electrolyte
 GI Function
 Characteristic of Stool

25. Nursing Diagnosis
 Diarrhea related to indigestion secondary to mal
absorption
 Imbalanced nutrition less than body requirement related
to indigestion secondary to diarrhea.
 Fluid and electrolyte imbalance related to indigestion
secondary to mal absorption

26.  Knowledge deficit related to hospitalization and mal
absorption disease
 Fear and anxiety related to hospitalization (in parents and
child)

27. Nursing Intervention
 Improvement of nutritional status by appropriate diet
planning and supplementation of deficient nutrition.
 Restoration of fluid and electrolyte balance by oral and
parenteral therapy
 Continuous monitoring and recording of patient’s
condition

28.  Relief of pain by medication and anti-diarrheal agents for
diarrhea as prescribed by doctor
 Maintenance of skin integrity specially perineal area
 Health education to parents about general cleanliness,
nutrition, hydration, danger sign, homecare and follow-up,
for necessary medical help.
 Relief of fear and anxiety about long term illness and
hospitalization by appropriate explanation, reassurance
and necessary support.

29. Bibliography
Books
 Wongs , Essentail Of Pediatric Nursing , Elsevier
Publisher, 10th Edition , Page no 732-733
 Parul data, Pediatric Nursing, 3rd edition, Jaypee
Publisher, page no 279-280
Reference
 https://www.healthline.com/health/malabsorption
 https://nurseslabs.com/diarrhea/#nursing-assessment